Pocket orthodontic bonding pad

ABSTRACT

A pocket orthodontic bonding pad for attaching orthodontic attachments to teeth wherein the orthodontic attachment is mechanically secured within a bonding pad pocket with a design that allows a slight buffering flexibility under masticatory stress and ease of removal of the orthodontic attachment. Upon removal of locking tabs the orthodontic attachment may be removed with minimal force, and the remaining bonding pad polished from the teeth with ease, which is most advantageous for brackets that tend to break upon removal and create high stress forces upon tooth structure. The ease of removing orthodontic attachments allows maximum bonding strengths.

This application is a divisional of U.S. patent application Ser. No.14/738,748, filed Jun. 12, 2015, which claims the benefit of U.S.Provisional Application No. 62/011,423, filed Jun. 12, 2014. Thedisclosure of these prior application are hereby incorporated byreference herein in their entireties for all purposes.

This invention relates in general to a polymer/plastic pocketorthodontic bonding pad for orthodontic attachments, mainly brackets.The pocket orthodontic bonding pad removably receives the orthodonticattachment which is locked into the pocket. Upon removal of the lock,the orthodontic attachment is removed with minimal pressure. This isparticularly advantageous for orthodontic brackets, which tend to breakupon removal. The pocket orthodontic bonding pad imparts a slight degreeof flexibility to the orthodontic attachment, which buffers againstmasticatory forces. The pocket orthodontic bonding pad further allowsmaximum-strength bonding materials bonding to the tooth, wherein thebonding pad is designed to be the breakaway force determinant for theorthodontic attachment, this force being less than the force beingnecessary to break tooth enamel from a tooth. This is particularlyadvantageous because direct bracket/enamel bonds universally createmicrofractures in enamel when removed or debonded from teeth.

BACKGROUND OF THE INVENTION

With the development of the ability to bond material to teeth, moreparticularly to tooth enamel, orthodontics was presented with bondablebrackets and attachments. The strength of the bracket bond to a toothwas determined by the combination of the strength of the bond to thetooth, the strength of the bonding material, and the strength of thebond to the orthodontic attachment. The bond to the orthodontic bracketwas facilitated by using bonding materials, such as acrylics, whichreadily formed a strong union with the bracket. Metal brackets and otherattachments were developed with a mesh-type bonding surface thatproduced a semi-mechanical lock with the bonding material. Plasticbrackets were easily broken and absorbed stains. Ceramic brackets werethen developed.

Ceramic brackets, as described in U.S. Pat. No. 4,948,366, were madefrom mono-crystalline or poly-crystalline aluminum oxide, which wereresistant to staining. The bonding surface of the ceramic bracket wastreated with a silane coupling agent in order to enhance the strength ofthe bond with the bonding material. The ceramic material was similar toa diamond, hard and brittle, resulting in a surface hardness greaterthan that of tooth enamel If the ceramic bracket had an occlusalinterference it would abrade the enamel of the opposing teeth. Theorthodontic company rushed to market with this new product byadvertising directly to the public, which created a public demand forthe product before adequate clinical trials had been performed.Clinically, the orthodontist found that when attempting to remove theceramic bracket from a patient's tooth, the tooth enamel wouldoccasionally detach with the ceramic bracket. The strength of theceramic bracket to enamel bond was greater than the enamel to theunderlying tooth. Research revealed that the smooth bonding surface ofthe ceramic bracket treated with a silane-coupler greatly enhanced theattachment of the bonding material to the ceramic bracket. It was alsofound that this type of flat surface on the ceramic bracket produced avery thin layer of bonding film, which in turn produced a stronger bond.The thinner the bonding film the stronger the bond.

Ceramic brackets are often removed with the jaws of an orthodontic pincutter by placing the cutting edges between the bracket base and thetooth and squeezing. The orthodontic ceramic bracket would oftenfracture upon attempted removal from the tooth, leaving a piece of theceramic bracket still bonded to the tooth. At this point a dental drillwould often have to be used to remove the piece of ceramic bracket fromthe tooth. The dental drill was not a perfect solution due to the natureof the hardness of the porcelain bracket. The dental drill most commonlyused was diamond-coated, which had close to the same hardness as theporcelain bracket, and which was harder than tooth enamel. The ceramicbracket was also the same color as tooth enamel Thus, tooth enamel couldbe inadvertently removed.

The mesh-backed metal brackets were more successful than the ceramicbracket. The mesh-backed metal bracket produced a greater thickness ofbonding material, allowing enough space between the bracket and thetooth to allow the pin cutter to more easily wedge between the bracketand tooth and remove the bracket when the pin cutter jaws were squeezedtogether. The metal brackets would not fracture as the porcelainbrackets did. The early metal brackets also had the ability to flex,wherein twin brackets could be gripped and squeezed by a pair of pliers,which broke the bond. Modernly, metal brackets are formed by metalinjection molding and do not possess this flexing ability yet still willremain in one piece during removal.

Several attempts have been made to solve the debonding problemassociated with ceramic brackets. For example, it was proposed in U.S.Pat. No. 4,455,138 that applying heat to the dental bracket would assistin loosening the adhesive bonding of the bracket to the tooth so thatthe ceramic bracket may be more easily removed with less force. It wasfound that this system was not always practical as the orthodontist mayprematurely pull the bracket in anticipation of the loosening ofadhesive, causing great pain to the patient and also shattering thebracket before the heat applied would loosen the adhesive. Further, thepulling force could not be directionally controlled with this system. Inaddition, the high temperatures associated with this method of removalcould cause pulpal or nerve damage to the tooth.

Another debracketing tool and method of removal is disclosed in U.S.Pat. No. 4,907,965, where the heat and debracketing force issimultaneously applied. This system does not always assure that theadhesive is sufficiently loose to allow easy removal, and likewiserequires engagement of the ceramic bracket during removal. In addition,the high temperatures associated with this method of removal could causepulpal or nerve damage to the tooth.

A relatively flexible bonding pad is described in U.S. Pat. No.5,098,288, wherein a bonding pad is secured to the bracket and bonded tothe surface of a tooth. The attached pad is gripped by pliers, causing abuckling of the pad, breaking the bond between the pad and the tooth.The purpose was to prevent fracturing of the bracket during the removalprocess. However, the flexibility of the bonding pad does not allow forhigher bonding strengths between the bonding pad and the enamel surface.In fact, increasing bonding strengths between the bonding pad and theenamel surface decreases flexibility of the bonding pad.

U.S. Pat. No. 5,263,859 describes a flexible bonding pad with holes,allowing the bonding material to come in direct contact with thebracket. The purpose was to increase the strength of the bond to thebracket. However, the flexibility of the bonding pad does not allow forefficient bonding strengths between the bonding pad and the enamelsurface. In fact, increasing bonding strengths between the bonding padand the enamel surface decreases flexibility of the bonding pad.

U.S. Pat. No. 6,786,720 discloses a light-curable methacrylate-basedepoxy resin bonding pad molded to a ceramic orthodontic appliance.Debonding is performed by squeezing the pad with ligature cutters,causing the bracket to release from the tooth. However, the flexibilityof the bonding pad does not allow for efficient bonding strengthsbetween the bonding pad and the enamel surface. In fact, increasingbonding strengths between the bonding pad and the enamel surfacedecreases flexibility of the bonding pad.

Another factor involving orthodontic brackets is the unintentionaldebonding during the patient's treatment which is time-consuming for theorthodontist, and often delays the completion of the patient'streatment. Most commonly, the patient has eaten something too hard.Orthodontics is moving toward digitally-assisted bracket placement. Ifone failure occurs in treatment, it is virtually impossible to replacethe bracket in the same position. With the trend in extended appointmentintervals (from traditional 4-week intervals to current 8-10-weekintervals), a broken bracket can greatly add additional treatment timeand significant cost to the orthodontist due to the process involved torepair the unintentionally broken bond. The dilemma is that orthodonticbond strengths must be strong enough to adhere brackets to teeth yetweak enough that upon removal they do not fracture enamel, causingdamage to the teeth. Further, the pulling force could not bedirectionally controlled with this system.

U.S. Pat. No. 7,819,660 discloses appliances that are not designed toresist or distribute masticatory shear forces of an occlusal gingivaldirection. The appliances rely on an expensive multitude of bracketbodies with different x-axis, y-axis, and z-axis positions.

Another debracketing tool and method of removal is disclosed in U.S.Pat. No. 4,907,965, wherein heat and debracketing force issimultaneously applied. This system does not always assure that theadhesive is sufficiently loose to allow easy removal, and likewiserequires engagement of the ceramic bracket during removal. In addition,the high temperatures associated with this method of removal could causepulpal or nerve damage to the tooth.

It is also known to provide a relatively flexible bonding pad or basefor an orthodontic bracket to facilitate debonding, as disclosed in U.S.Pat. No. 5,098,288. However, it has been found that the bonding betweenthe pad and the bracket often fails during treatment due to the variousforces on the bracket during treatment, thereby necessitatingre-bonding. Further, the flexibility of the bonding pad does not allowfor efficient bonding strengths between the bonding pad and the enamelsurface. In fact, increasing bonding strengths between the bonding padand the enamel surface decreases flexibility of the bonding pad. In suchinstances, treatment has been interrupted, delaying the ultimateconclusion of treatment, and costly chair time is required to re-bondthe bracket to the tooth.

SUMMARY OF THE INVENTION

Orthodontics is moving toward digitally-assisted bracket placement. Ifone failure occurs in treatment, it is virtually impossible to replacethe bracket in the same position. With the trend in extended appointmentintervals (from traditional 4-week intervals to current 8-10-weekintervals) a broken bracket can greatly add additional treatment time.The dilemma is that orthodontic bond strengths must be strong enough toadhere brackets to teeth yet weak enough that upon removal they do notfracture enamel or damage teeth.

Tavas and Watts reported that shear/peel strengths of bonded adhesivesshould develop 3.9 to 5.9 MPa. While this relatively weak bond strengthensures easy removal of brackets, it also leaves the patient verysusceptible to broken brackets through normal masticatory forces or notadhering to a brace-friendly diet. Literature reports bond strengths to15 MPa with orthodontic adhesives. Enamel bond strengths of up to 38.3MPa are currently possible with modern dental materials and it wouldfollow that higher bond strengths will continue to evolve as time goeson. By increasing bond strengths, orthodontic appliances need not relyon surface area for bond strength, permitting orthodontic appliances tobe much smaller. Smaller orthodontic appliances are particularlyadvantageous to dental aesthetics, comfort, and access for hygiene.

Brackets tend to debond through masticatory shear forces in an occlusalgingival direction. Therefore, a bracket that is resistant to this forcevector and shock-absorbing to this force vector would be desired. Slightflexibility of the bonding pad tends to mitigate the effects of theseshear forces. Current debonding techniques require the orthodontist toremove adhesive remnants from the teeth using a fine fluted finishingbur. Most adhesive remains on the teeth, so it is normal protocol andprocedure that this removal process is common. The bonding pads of thepresent invention and adhesive can be limitless in mechanical andchemical adhesion to teeth, while negating debonding forces to removebonding pads from teeth. Further, the bonding pads of the presentinvention are thin and easily destructible, further providing for easyremoval.

The concept of the bonding pad is to (1) enable very high bond strengthat the pad-enamel interface (chemical/etch retention) through apolymeric/plastic bonding pad that is mechanically attached to theattachment body; (2) enable the orthodontist to remove attachments atvery low forces due to the unique design of the bonding pad/attachmentinterface, such that with a simple adjustment to the bonding pad,mechanical retention of the orthodontic attachment body to the bondingpad is reduced from high strength to near zero; and (3) design thebonding pad/attachment to allow shock absorption to distributemasticatory force. The occlusal-gingival, mesial-distal, andlingual-labial positions are made within the bonding pad's shape, butpermit the use of a singular, standard attachment body, which tends tobe the expensive and intricate component, especially with the advent ofself-ligating orthodontic brackets that have multiple moving parts. Thebonding pads are particularly suited to be individually fabricated,preferably specifically to the anatomy of each tooth of a patient,preferably specifically to the occlusal-gingival, mesial-distal, andlingual-labial positions on each tooth of a patient, and preferablyprinted by a three-dimensional printer.

The present invention enables the orthodontist to lower the forces atthe debond appointment by a simple manipulation of the amount ofmechanical retention of the orthodontic attachment to the bonding pad. Ametal, ceramic, or polymer orthodontic attachment with a smooth basesurface can be preferably shaped such that the gingival side isoptionally narrow and tapers to a wider occlusal side. Alternatively,the metal, ceramic, or polymer orthodontic attachment with a smooth basesurface can be preferably shaped such that the occlusal side isoptionally narrow and tapers to a wider gingival side. In alternativeembodiments, either of the left and right sides may be optionally narrowand tapered relative to the other. This preferable tapering ensures aneasy path of draw in an occlusal direction. Optimal, preferable occlusalor gingival tapering also ensures resistance from an occlusal-gingivaldirection. The orthodontic attachment is enveloped mechanically in thebonding pad. The bonding pad can optionally be made out of a plastic orpolymer that is similar to the bonding adhesives. Further, the bracketcannot be removed from the bonding pad unless the pad is destroyed byremoval of locking features, thus creating an irreversible assembly fora more solid structure. This is particularly advantageous becausereusable orthodontic bracket assemblies must balance the strength ofbonding that permits bracket assembly removal and subsequentreattachment to a patient's tooth with the strength of bonding thatprevents accidental dislodgement. The bonding pad of the presentinvention does not rely on flexibility to debond the attachment;instead, a rotary instrument is used to polish. Further, addition of anorthodontic attachment to the bonding pad adds rigidity to the bondingpad by acting as an underlying framework to support the bonding pad. Thepolymer mesh could optionally be impregnated with an anti-cariogenic ornaturally occurring molecule with the ability to release calcium andphosphate ions, stabilize, and/or mitigate the common occurrence ofenamel decalcification that is common around orthodontic bonding pads,such as fluoride, selenium, calcium, casein phosphopeptide (“CPP”), oramorphous calcium phosphate (“ACP”).

During debonding of the present invention, no shear forces orcompressive forces need be applied to the interface between the bondingpad and tooth enamel Instead, the mechanical tab securing theorthodontic attachment or in the retentive aspects of the bonding pad isremoved or polished away. Subsequently, a pliers or debonding toolengages the orthodontic attachment and lifts the attachment out of thepocket of the bonding pad in a gingival to occlusal direction. Thisdebonding procedure eliminates the need to apply a prying or pullingforce directly to the interface between the enamel and the bonding pador orthodontic attachment, mitigating the enamel microfracture damagethat occurs to tooth enamel during the typical debonding process.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1A is a perspective view of the pocket orthodontic bonding pad.

FIG. 1B is a perspective view of the pocket orthodontic bonding pad withthe upper part hinged open.

FIG. 2 is a perspective view of an orthodontic attachment with a femalereceptacle in the base.

FIG. 3 is a frontal view of the orthodontic attachment stem wherein thebase is locked within the pocket orthodontic bonding pad with protrudingsurfaces and a central protruding surface;

FIG. 4 is a cross-section of FIG. 3 through D-D showing a cross-sectionof the orthodontic bracket;

FIG. 5 is a cross-section of FIG. 3 through C-C.

FIG. 6 is a frontal view of the orthodontic attachment stem wherein thebase is locked within the pocket orthodontic bonding pad with protrudingsurfaces.

FIG. 7 is a cross-section of FIG. 6 through E-E showing a cross-sectionof the orthodontic attachment.

FIG. 8 is a perspective view of the pad wherein theattachment-containing pad is attached to a tooth and a dental drill isused to remove the protruding surfaces.

FIG. 9 is a perspective view showing an orthodontic band removerremoving the orthodontic attachment from the bonding pad.

FIG. 10 is a perspective view showing a dental handpiece with a grindingstone removing the bonding pad from the surface of the tooth.

FIG. 11 is a rear view of an orthodontic attachment embodiment with arelief channel

FIG. 12 is a perspective view of the orthodontic attachment shown inFIG. 11.

FIG. 13 is a perspective view of the orthodontic attachment with arelief channel with mesial-distal pressure exerted such that the bracketis compressed inward into the relief channel

FIG. 14 is a top cross-section view of an orthodontic attachment with arelief channel reversibly received into a pocket orthodontic bonding padwith a spine.

FIG. 15 is a top cross-section view showing application of mesial-distalpressure to an orthodontic attachment with a relief channel reversiblyreceived into a pocket orthodontic bonding pad with a spine.

FIG. 16 is a perspective view of an alternative embodiment of anorthodontic bonding pad attached to a tooth.

FIG. 17A is a perspective view of an orthodontic attachment that hasreversibly received the orthodontic bonding pad of FIG. 16.

FIG. 17B is a perspective view showing a dental drill removing aprotruding surface from the orthodontic bonding pad in FIG. 17A.

FIG. 17C is a perspective view showing an orthodontic band removerremoving the orthodontic attachment from the bonding pad in FIG. 17A.

FIG. 17D is a perspective view showing the bonding pad of FIG. 17A afterthe protruding surface has been removed and the orthodontic attachmentlifted off.

FIG. 17E shows showing a dental handpiece with a grinding stone removingthe bonding pad of FIG. 17D from the surface of the tooth.

FIG. 18A is an occlusal-gingival cross-section of an alternativeembodiment of an orthodontic bonding pad with a living hinge that hasbeen reversibly received by an orthodontic attachment.

FIG. 18B is an occlusal-gingival cross-section showing the movement ofthe orthodontic bonding pad of FIG. 18A when open, the bonding surfaceof the orthodontic bonding pad not bonded to the enamel of a tooth.

FIG. 18C is a mesial-distal cross-section of the orthodontic attachmentin FIG. 18A that has reversibly received the orthodontic bonding pad.

FIG. 19 is a perspective view showing an alternative embodiment of anorthodontic bonding pad with a living hinge on the bonding surface.

FIG. 20 is a perspective view of an orthodontic attachment that hasreversibly received the orthodontic bonding pad of FIG. 19.

FIG. 21 is a lingual-labial cross-section of an alternative embodimentof an orthodontic bonding pad that has received an orthodonticattachment.

FIG. 22 shows a single tooth of a replica of an individual patient'stooth.

FIG. 23 is a perspective view of the single tooth shown in FIG. 22.

FIG. 24 is a back view of an embodiment of an orthodontic bonding padthat has received an orthodontic attachment.

FIG. 25 is a back view of an alternative embodiment of the orthodonticbonding pad shown in FIG. 24.

FIG. 26 is a perspective view of an alternative embodiment of the toothshown in FIG. 23.

FIG. 27 is a perspective view of an embodiment of an orthodontic bondingpad with an occlusal index attached.

FIG. 28 is a frontal view of a tooth of a patient with the orthodonticbonding pad of FIG. 27 that has reversibly received an orthodonticattachment.

DETAILED DESCRIPTION OF THE EMBODIMENTS

The present invention relates to an orthodontic attachment bonding padthat contains retentive aspects that receive an orthodontic attachmentand has a bonding surface that bonds to a tooth. The design of thepocket is to allow the removal of the attachment with minimal pressure.The pocket orthodontic bonding pad is comprised of a polymer/plasticmaterial that is comprised of a highly bondable material that is of ahardness such that it can be easily removed from a tooth with a dentaldrill. The material and the design of the pocket orthodontic bonding padare intended to produce a shock absorbing effect. The x-, y-, andz-directional axes are subsequently referred to and claimed by referenceto mesial-distal, occlusal-gingival, and lingual-labial axes forrelation to human anatomical dimensions, without respect tocorresponding axes; no representation is made, for example, that thex-axis need be limited to specifically correspond to one ofmesial-distal, occlusal-gingival, or lingual-labial over either of theothers two. Additionally, “torque” refers to the rotation of a tooth onits long axis, especially the movement of the apical portions of theteeth by use of orthodontic appliances. “Angulation” refers to thedeviation of a tooth from a straight line, i.e. an occlusal-gingivalaxis. “Tipping” refers to forcibly pivoting a tooth so that its crown ismoved labially or lingually.

FIG. 1A shows an embodiment of the pocket orthodontic bonding pad 1 withretentive aspects consisting of an internal pocket 2 defined byoptionally tapered sides 3 and a top occlusal side 4 and lower gingivalside 5. The top occlusal side 4 partially or fully encloses the internalpocket 2 with one or more locking tabs 6 a.

FIG. 1B shows an embodiment of the pocket orthodontic bonding pad 1wherein the back of the pad 15 is tipped to open at the top occlusalside 4 of the internal pocket 2, hinged by the living hinge 6 b. The topocclusal side 4 faces the chewing surfaces of the teeth. The topocclusal side 4 also contains a male surface 6 c that protrudes into theinternal pocket 2 area. Once the pocket orthodontic bonding pad 1 isclosed and is bonded to the enamel surface of a patient's tooth, theliving hinge 6 b is irreversibly closed over an orthodontic attachmentdue to the contact with the enamel surface of a patient's tooth, and theorthodontic attachment is retained in the internal pocket 2 until themale surface 6 c or top occlusal side 4 is removed. Brackets tend todebond from masticatory shear forces from the occlusal direction becausethere is no shock-absorbing effect to the enamel/bonding pad interface.

FIG. 2 shows an embodiment of an orthodontic attachment 6 e with a stem7 attached to a base 8. The base 8 has a bottom gingival side, 9, anupper occlusal side 11, and left and right sides 12. The left and rightsides 12 may optionally be tapered, and widen towards the upper occlusalside 11. Alternatively, the left and right sides 12 may optionally betapered, and widen towards the bottom gingival side 9. The orthodonticattachment 6 e of FIG. 2 inserts within the internal pocket 2 of FIG. 1Awherein A1 aligns with A2 and B1 aligns with B2.

FIG. 3 shows the base 8 within the internal pocket 2, the stem 7centrally, and the male surface 6 c seated within the female receptacle6 d. The male surface 6 c and female receptacle 6 d are optionalfeatures and neither the pocket orthodontic bonding pads nor orthodonticattachments of the present invention are limited to embodimentsincluding a male surface 6 c and/or female receptacle 6 d.

FIG. 4 shows a cross-section through D-D of FIG. 3. A male surface 6 clocks the base 8. The bonding surface 13 of the pocket orthodonticbonding pad 1 is irregular, which enhances the strength of the bond.Because the pocket orthodontic bonding pad 1 is not forcibly removedfrom a tooth, but instead polished off of a tooth, the irregularity ofthe bonding surface 13 is limitless, thus enhancing the mechanicalretention of the adhesive to the bonding pad.

FIG. 5 is a cross-section of FIG. 3 through C-C. The top occlusal side 4of the pocket orthodontic bonding pad 1 wherein the locking tabs 6 aenclose the base 8. The front side 16 of the pocket orthodontic bondingpad 1 completes the enclosure of the base 8. It is desirable that thepocket orthodontic bonding pad 1 have a shock-absorbing effect in orderto resist the chewing forces. The shock-absorbing effect is determinedby the material and the design of the pocket orthodontic bonding pad 1.The break-away release force of the orthodontic attachment 6 e is theforce required to dislodge the orthodontic attachment 6 e from thepocket orthodontic bonding pad 1. The break-away force is determined bythe locking tabs 6 a or top occlusal side 4, the optional male surface 6c engaging the optional female receptacle 6 d or upper occlusal side 11of the base 8, and the front of the pocket orthodontic bonding pad 1. Itis important that the break-away force to intentionally release theattachment from the bonding pad is less than the force to remove enamelfrom a tooth. The ability to keep the orthodontic attachment 6 e on atooth is only compromised when the locking tabs 6 a, top occlusal side4, or male surface 6 c is removed. Conversely, it is important that theretention force be great enough to retain the orthodontic attachment 6 efor the duration of the treatment. Besides being time-consuming toreplace an orthodontic attachment 6 e, modern orthodontics is turning tocomputer-positioned attachments and 8-10 week appointment intervals,where it is virtually impossible to replace an attachment in itsoriginal computer-selected position.

FIG. 6 discloses another embodiment wherein the pocket orthodonticbonding pad 1 has a tab 17 at the top occlusal side 4 that encloses thebase 8 as shown in FIG. 7.

FIG. 7 shows a cross-section of FIG. 6 through E-E wherein the occlusalportion of the base 8 is enclosed by the tab 17.

FIG. 8 discloses the pocket orthodontic bonding pad 1 bonded to a tooth20 with the tooth occlusal 21 facing upwards and the pocket orthodonticbonding pad 1 upper occlusal side 11 facing upwards. A dental drill 22attached to a dental handpiece 23 is used to remove the locking tabs 6 aand the male surface 6 c. The orthodontic attachment 6 e is now open tothe upper occlusal side 11. The optionally tapered sides 3 and left andright sides 12, as shown in FIGS. 1, 2, 3, and 6, further facilitate theremoval in an occlusal 21 direction with minimal pressure. Theorthodontic attachment 6 e may be removed without breakage to theorthodontic attachment 6 e or tooth 20. This is particularlyadvantageous for removing attachments, which are prone to breakageduring removal. Pieces of a broken bracket left on a tooth frequentlyhave to be ground off, using very aggressive cutting instruments and/ordiamonds, which is difficult due to hardness of the material. Thegrinding process with these aggressive cutting instruments and/ordiamonds may also inadvertently remove underlying tooth 20 enamel.

FIG. 9 shows an orthodontic band-removing pliers 24 used to remove theorthodontic attachment 6 e from the pocket orthodontic bonding pad 1 inan occlusal 21 direction. This removal requires minimal pressure, whichis comfortable for the patient and does not run the risk of breaking theorthodontic attachment 6 e. The lack of breakage of the orthodonticattachment 6 e is especially advantageous as brackets are very prone tobreakage during removal.

FIG. 10 shows a dental handpiece 23 with a polisher 22 removing theremainder of the pocket orthodontic bonding pad 1 from the tooth 20. Thepocket orthodontic bonding pad 1 is comprised of a material softer thantooth enamel, which allows easy removal. The pocket orthodontic bondingpad 1 is comprised of a polymer or acrylic, which is firm enough toretain the orthodontic attachment 6 e, flexible enough to allow someflexion of the orthodontic attachment 6 e, flexible enough to allow someflexion of the orthodontic attachment 6 e within the pocket orthodonticbonding pad 1, and soft enough to allow the pocket orthodontic bondingpad 1 to be easily polished off the tooth 20 as shown in FIG. 10.

FIG. 11 shows the rear view of an orthodontic attachment 6 f with a stem26 attached to a base 25 with an upper occlusal side 25 a and a lowergingival side 25 b. The base 25 is bifurcated along theocclusal-gingival axis, with a relief channel 6 g between the halves ofthe bracket base 25, and extending into the stem 26, as seen in FIG. 12.The base 25 has a smooth outer surface 27.

FIG. 13 is a perspective view of the orthodontic attachment 6 f withmesial-distal pressure 28 applied such that the halves of base 25 arecompressed inward into the relief channel 6 g. The compression allowsthe orthodontic attachment 6 f to be removed from a pocket orthodonticbonding pad with minimal pressure, by removing the periphery of the basefrom the retentive aspects of the bonding pad.

FIG. 14 is a top-cross-section view of an orthodontic attachment 6 fwith a relief channel 6 g reversibly received into a pocket orthodonticbonding pad 30 with a spine 29 and internal pocket 31. The bifurcatedhalves of the bracket base 25 flank the sides of the spine 29. The spine29 is an optional feature of pocket orthodontic bonding pad 30 and is byno means intended to limit the presently claimed inventions to thecurrently described embodiment.

FIG. 15 shows the application of mesial-distal pressure to anorthodontic attachment 6 f reversibly with a relief channel 6 greversibly received into a pocket orthodontic bonding pad 30 with aspine 29. The spine 29 diverts the compressed halves of the base 25outward away from the pocket orthodontic bonding pad 30, allowing theorthodontic attachment 6 f to be removed with minimal pressure. Thespine 29 is an optional feature of pocket orthodontic bonding pad 30 andis by no means intended to limit the presently claimed inventions to thecurrently described embodiment.

FIG. 16 is a perspective view of an embodiment of an orthodontic bondingpad 31 bonded to a tooth 20. The orthodontic bonding pad 31 has a topocclusal side 35 and a bottom gingival side 36. The stem 32 is in theshape of a female depression attached to the front of the bonding padbase 39. The head 33 is attached to the end of the stem 32 opposite thatattached to the base 39. A protruding surface 34 is attached centrallyon the top occlusal side, preferably flush with the bonding surface, andcan lock an orthodontic attachment received by the orthodontic bondingpad 31 in place until the protruding surface 34 is removed.

FIG. 17A is a perspective view of an embodiment of an orthodonticattachment 37 that has reversibly received the head 33 of theorthodontic bonding pad 31 shown in FIG. 16. The orthodontic attachmenthas a top occlusal side 38 that is locked in receiving position byprotruding surface 34. The orthodontic attachment 37 cannot be removedfrom the orthodontic bonding pad 31 until the male tab 34 on theorthodontic bonding pad 31 has been removed. FIG. 17B shows a dentalhandpiece 23 with a drill 22 removing the protruding surface 34 fromorthodontic bonding pad 31. The orthodontic attachment 6 e may beremoved without breakage to the orthodontic attachment 37 or tooth 20.This is particularly advantageous for removing attachments, which areprone to breakage during removal. Pieces of a broken bracket left on atooth frequently have to be ground off, using very aggressive cuttinginstruments and/or diamonds, which is difficult due to hardness of thematerial. The grinding process, using very aggressive cuttinginstruments and/or diamonds, may also inadvertently remove underlyingtooth 20 enamel

FIG. 17C shows an orthodontic band-removing pliers 24 used to remove theorthodontic attachment 37 from the pocket orthodontic bonding pad 31 inan occlusal direction. This removal requires minimal pressure, which iscomfortable for the patient and does not run the risk of breaking theorthodontic attachment 37. The lack of breakage of the orthodonticattachment 37 is especially advantageous as brackets are very prone tobreakage during removal. FIG. 17D shows the orthodontic bonding pad 31after the orthodontic attachment 37 has been removed. The protrudingsurface 34 in FIG. 16 had to be removed in order to remove theorthodontic attachment 37. FIG. 17E shows a dental handpiece 23 with apolisher 22 a removing the remainder of the orthodontic bonding pad 31from the tooth 20. The pocket orthodontic bonding pad 31 is comprised ofa material softer than tooth enamel, which allows easy removal. Theorthodontic bonding pad 31 is comprised of a polymer or acrylic, whichis firm enough to be locked in the orthodontic attachment 37, flexibleenough to allow some flexion of the orthodontic attachment 37 around theorthodontic bonding pad 31, and soft enough to allow the orthodonticbonding pad 31 to be easily polished off the tooth 20. The orthodonticbonding pad 31 and orthodontic attachment 37 may each be optionallytapered to the occlusal or gingival for resistance from and path of drawin removal.

FIG. 18A shows an occlusal-gingival cross-section of the orthodonticbonding pad 39 that has reversibly received an orthodontic attachment.The bonding surface has a a mesial-distal living hinge 40 on the bondingsurface such that the top occlusal side and protruding surface 41 canreversibly engage the upper occlusal side of an orthodontic attachment37, and the living hinge 40 is locked, and cannot be opened, uponbonding of the bonding surface of the orthodontic bonding pad 39 to theenamel of a tooth such that the head of the orthodontic bonding pad 39is locked inside the retentive aspects of the orthodontic attachment 37until the protruding surface 41 is removed. FIG. 18B shows the movementof living hinge 40 of FIG. 18A when the bonding surface of orthodonticbonding pad 39 is not bonded to the enamel of a tooth. Orthodonticattachment 37 can reversibly receive the head of orthodontic bonding pad39 when the bonding surface of orthodontic bonding pad 39 is not bondedto the enamel of a tooth. FIG. 18C shows a mesial-distal cross-sectionof the embodiment of FIG. 18A, with the retentive aspects 44, shown herein the form of rails, of the orthodontic attachment 37 receiving thehead 43 of the orthodontic bonding pad 39 by sliding into the stem 42,shown here in the form of female depressions, of the orthodontic bondingpad 39. The protruding surface 41 is an occlusal aspect of the livinghinge 40 on the top occlusal side, and locks the orthodontic attachment37 in place until the protruding surface 41 or top occlusal side isremoved.

FIG. 19 is a perspective view of the orthodontic bonding pad 39 shown inFIGS. 18A, 18B, and 18C. The orthodontic bonding pad 39 has a protrudingsurface 41 that eclipses the top occlusal side 45 when the living hinge40 is closed.

FIG. 20 is a perspective view of the orthodontic bonding pad 39 shown inFIG. 19 bonded to a tooth 20, the orthodontic bonding pad 39 lockedinside an orthodontic attachment 37 until the protruding surface 41 isremoved.

FIG. 21 shows a lingual-labial cross-section view of an orthodonticbonding pad 47 that has received the base 48 of an orthodonticattachment with stem 52. This alternative embodiment has retentiveaspects in the form of tab 51 on the bottom gingival side and protrudingsurface 49 on the top occlusal side, and optional tabs 50 on the leftand right sides.

FIG. 22 shows a replica tooth 53, preferably a three-dimensionallyprinted replica of a patient's tooth. Computer software determines thelocations of positional markers 54, which will cooperatively engage anorthodontic bonding pad such that the orthodontic bonding pad isappropriately positioned in the desired location on the tooth 53, asindicated by silhouette 55.

FIG. 23 shows the replica tooth 53 of FIG. 22, with orthodontic bondingpad 56, which will be preferably three-dimensionally printed tocooperatively engage the positional markers 54, and which willreversibly receive orthodontic bonding pad 57.

FIG. 24 shows the back view of the bonding surface of orthodonticbonding pad 56, which has reversibly received orthodontic attachment 58.The bottom gingival side of the orthodontic bonding pad 56 isspecifically shaped with notches 59 to cooperatively engage the twopositional markers 54 on replica tooth 53. By pre-determining positionsof orthodontic bonding pads 56, an orthodontist's assistant can prepareentire upper and lower jaw sets of properly positioned orthodonticbonding pads 56 on printed models, with positional markers 54 of theindividual patient's dentition for the fabrication of indirect bondingtrays, by matching up positional markers 54 to notches 59. This isparticularly advantageous because a doctor need only select positions oforthodontic attachments, and the replica tooth 53 and orthodonticbonding pad 56 are preferably three-dimensionally printed and positionedfor quick bonding by an assistant, saving an orthodontist time.

FIG. 25 shows an alternative embodiment of orthodontic bonding pad 56with a specifically shaped singular bottom gingival side with irregularnotch 59, which identically matches the singular positional markerallowing occlusal-gingival, mesial-distal, and lingual-labialpositioning of bracket to tooth.

FIG. 26 shows an alternative embodiment to the replica tooth 53 of FIG.22, wherein a male-projection hash mark 61 is matched to a femalesimilar mark 63 on the orthodontic bonding pad 62 for properpositioning. The advantage of the female similar mark 63 on theorthodontic bonding pad 62 is that it allows a defined hollow in theorthodontic bonding pad 62 to be filled with adhesive, ensuring a verythin coat of adhesive so that there will be minimal adhesive flash toclean up around the periphery of the orthodontic bonding pad 62 andorthodontic attachment 57 once attached. The orthodontic bonding pad 62can reversibly receive orthodontic attachment 57.

FIG. 27 shows an orthodontic bonding pad 57 with an integrated index 64attached on the top occlusal side. Ideally, the entire orthodonticbonding pad 57 and integrated index 64 assembly arethree-dimensionally-printed in combination with orthodontic bonding pad57 and integrated index 64 assemblies for an entire upper jaw or lowerjaw set. The specific distance and projectional path between theintegrated index 64 and the orthodontic bonding pad 57 reflects thecalibrated positioning of the orthodontic bonding pad 57 in order tocontrol occlusal-gingival, mesial-distal, and lingual-labial positioningof the orthodontic bonding pad 57 on the patient's tooth. This isparticularly advantageous because the anatomy of the tooth is capturedin the integrated index 64 such that when the integrated index 64 isapplied to the comparable tooth of the patient, the orthodontic bondingpad 57 will be bonded in the pre-selected position. This saves anorthodontist time in positioning orthodontic bonding pad 57 and the needto create a transfer or indirect bonding tray.

FIG. 28 shows a front view of a patient's tooth 20. The integrated index64 has cooperatively engaged the occlusal surface of the tooth such thatthe orthodontic attachment 65, and the orthodontic bonding pad 57 (notshown) that has reversibly received the orthodontic attachment 65, willbe placed in the pre-selected position on the tooth 20. Subsequent tobonding, orthodontic device 66 is used to cut the integrated index 64from the orthodontic bonding pad 57 (not shown).

While the invention has been illustrated by a description of variousembodiments and while these embodiments have been described inconsiderable detail, it is not the intention of the applicants torestrict or in any way limit the scope of the appended claims to suchdetail. Additional advantages and modifications will readily appear tothose skilled in the art. The invention in its broader aspects istherefore not limited to the specific details, representative methods,and illustrative examples shown and described. Accordingly, departuresmay be made from such details without departing from the spirit or scopeof the inventive concept.

I claim:
 1. A pocket orthodontic bonding pad, comprising: a four-sidedpad with a top occlusal side, a bottom gingival side, left and rightsides, a front and a back and retentive aspects, wherein the retentiveaspects are on the left side, the bottom gingival side, and the rightside of the four-sided pad, and the four-sided pad is open to the topocclusal side, and the retentive aspects can receive an orthodonticattachment; a male surface located on the top occlusal side, wherein themale surface retains a base of an orthodontic attachment in theretentive aspects during orthodontic treatment; a bonding surface on theback of the four-sided pad, wherein the bonding surface is irregular inorder to enhance a bonding strength of the bonding surface; anintegrated index on the top occlusal side of the four-sided pad; and aspecific distance and projectional path between occlusal end of theintegrated index and the four-sided pad; wherein the removal of the baseof the orthodontic attachment is dependent upon prior removal of theprotruding surface or upon prior removal of one of the retentiveaspects; wherein the back of the four-sided pad comprises a shapecomprising specific occlusal-gingival, mesial-distal, and lingual-labialdimensions; and wherein the specific distance and projectional pathdetermine the position of the pocket orthodontic bonding pad on a tooth,and the specific occlusal-gingival, mesial-distal, and lingual-labialdimensions align the orthodontic attachment at a specific,pre-determined occlusal-gingival, mesial-distal, lingual-labial positionand torque when the orthodontic attachment base is received by theretentive aspects of the pocket orthodontic bonding pad.
 2. A pocketorthodontic bonding pad as in claim 1, wherein the four-sided padfurther comprises one or more specifically shaped notches on the bottomgingival side.
 3. Positional markers on a replica of a patient's toothsuch that the positional markers cooperatively engage the one or morespecifically shaped notches on the bottom gingival side of thefour-sided pad of the pocket orthodontic bonding pad as in claim
 2. 4. Apocket orthodontic bonding pad as in claim 1, further comprising aliving hinge on the back of the four-sided pad in a mesial-distaldirection, the living hinge allowing the top occlusal side to be openedsuch that the retentive aspects of the four-sided pad can receive thebase of an orthodontic attachment, and wherein the living hinge isirreversibly closed once the bonding surface is attached to a tooth suchthat the base of the orthodontic attachment is retained in the retentiveaspects until one of the retentive aspects or the male surface isremoved.
 5. A pocket orthodontic bonding pad as in claim 1, wherein atleast the bottom gingival side of the four-sided pad further comprisesone or more specifically shaped notches such that the one or morespecifically shaped notches cooperatively engages pre-determinedpositional markers on a three-dimensional replica of a patient's toothcorresponding to a pre-determined occlusal-gingival, mesial-distal,lingual-labial position of the patient's tooth, the pocket orthodonticbonding pad subsequently bonded to the enamel of the patient's toothsuch that the orthodontic attachment received by the pocket orthodonticbonding pad is aligned at a pre-determined occlusal-gingival,mesial-distal, lingual-labial position and, optionally, can achieveddesired torque, angulation, and/or tipping.
 6. A pocket orthodonticbonding pad as in claim 1, wherein the retentive aspects on the left andright sides of the four-sided pad taper wider to the occlusal,facilitating removal of the orthodontic attachment to the occlusalfollowing the removal of the male surface using a device such as adental drill, the removal of the orthodontic attachment with the use ofan orthodontic instrument.
 7. A pocket orthodontic bonding pad as inclaim 1, wherein the retentive aspects on the left and right sides ofthe four-sided pad taper wider to the gingival, facilitating removal ofthe orthodontic attachment to the occlusal following the removal of themale surface using a device such as a dental drill, the removal of theorthodontic attachment with the use of an orthodontic instrument.
 8. Apocket orthodontic bonding pad as in claim 1, wherein the retentiveaspects are a hollow pocket that is enclosed on the left, bottomgingival, and right sides, and open to the top occlusal side, and thatcan receive the orthodontic attachment.
 9. A pocket orthodontic bondingpad as in claim 1, wherein the retentive aspects are tabs on the bottomgingival, and optionally the left and right sides of the four-sided pad,which can receive the orthodontic attachment base.
 10. A pocketorthodontic bonding pad as in claim 1, wherein the bonding strengthbetween the bonding surface of the pocket orthodontic bonding pad and anenamel surface of a tooth is at least 12 MPa.
 11. A pocket orthodonticbonding pad as in claim 1, further comprising a spine in the middle ofthe front side of the four-sided pad from the top occlusal side to thebottom gingival side, the spine protruding outward from the four-sidedpad of the pocket orthodontic bonding pad, the spine tilling a reliefchannel in the orthodontic attachment with a relief channel, theorthodontic attachment received in the hollow pocket of the pocketorthodontic bonding pad, and the spine diverting the orthodonticattachment with the relief channel outward or away from the pocketorthodontic bonding pad upon application of mesial-distal pressure tothe orthodontic attachment with the relief channel.
 12. A pocketorthodontic bonding pad as in claim 1, further comprising a spine in themiddle of the front side of the four-sided pad from the left side to theright side, the spine protruding outward from the four-sided pad of thepocket orthodontic bonding pad, the spine filling a relief channel inthe orthodontic attachment with a relief channel, the orthodonticattachment received in the hollow pocket of the pocket orthodonticbonding pad, and the spine diverting the orthodontic attachment with therelief channel outward or away from the pocket orthodontic bonding padupon application of occlusal-gingival pressure to the orthodonticattachment with the relief channel.
 13. A pocket orthodontic bonding padas in claim 1 that is an output of a three-dimensional printing device.14. A pocket orthodontic bonding pad as in claim 1, wherein the bottomgingival side, left side, or right side, or the bonding surface of thefour-sided pad has one or more specificallv shaped notches or femalemarks that individually or together form a unique pattern, and thatuniquely and cooperatively engage corresponding positional markers, on areplica of a patient's tooth.
 15. Positional markers on a replica of apatient's tooth such that the positional markers cooperatively engagethe one or more specifically shaped notches or female marks that arelocated on the bottom gingival side, left side, or right side, or thebonding surface of the four-sided pad of the pocket orthodontic bondingpad as in claim 14.